Provider Demographics
NPI:1295880706
Name:KIM, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1234742085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGX239SMedicare PIN
CAGX239XMedicare PIN
CAGX239QMedicare PIN
CAGX239AMedicare PIN
CAGX239EMedicare PIN
CAGX239PMedicare PIN
CAGX239ZMedicare PIN
CAGX239CMedicare PIN
CAGX239MMedicare PIN
CAGX239WMedicare PIN
CAGX239YMedicare PIN
CAGX239DMedicare PIN
CAGX239IMedicare PIN
CAGX239TMedicare PIN
CAGX239VMedicare PIN
CAGX239GMedicare PIN
CAGX239HMedicare PIN
CAGX239RMedicare PIN
CAGX239BMedicare PIN
CAGX239FMedicare PIN
CAGX239OMedicare PIN
CAGX239UMedicare PIN